Care and treatment provided by the pedicure-podiatrist

 Treatments with podiatric orthoses

The production of podiatric orthoses may be proposed in the event of static and dynamic disorders of the foot or of the musculoskeletal system in order to attenuate, as far as possible, these disorders and to avoid recurrences (reappearance of pain or increase in nail curvature).

Evaluate the results obtained by an orthotic treatment

It is important to evaluate the results obtained by the orthotic treatment with regard to several criteria: the reduction of the symptoms at the origin of the prescription, the occurrence of possible side effects, the impact on pain, the impact on functional abilities of the patient standing and walking and finally the need to continue or suspend orthotic treatment.

Regardless of the type of orthosis prescribed, instructions must be given to the patient when fitting the orthosis, on advice for use and maintenance (duration of daily wear, estimated duration of treatment, hygiene , possible side effects) and on the importance of consulting in the event of an adverse event occurring following the use of the orthosis.

Plantar orthoses: to reduce pain and distribute pressure

Plantar orthoses aim to distribute pressure, control and modify movements when walking and limit friction. It is necessary to carry them out after a comprehensive static and dynamic podo-postural podiatry assessment, and a gait examination.

Plantar orthoses are indicated to maintain or improve functional capacities (stability and locomotion) by reducing painful symptoms, by preventing or compensating for the aggravation of deformities, by passively supporting the osteoarticular elements of the foot; by preventing skin disorders and ensuring optimal distribution of plantar pressure; and finally by promoting the healing of wounds by reducing pressure or eliminating friction on this area.

Only plantar orthoses on medical prescription can benefit from a basis for reimbursement by Social Security.

Certain contraindications must be respected in the presence of trophic disorders of vascular, neurological, metabolic origin and plantar hypoesthesia (base of the orthosis sufficiently hard). It is important to check the correct adaptation of the plantar orthosis to the foot and to the footwear.

Follow-up appointments will be essential for a possible adaptation of the equipment and the evaluation of the use and wear of the orthoses worn. The life of the orthosis should not exceed one year. There is no professional consensus on the methods of making plantar orthoses.

Orthoplasties (toe orthoses)

Orthoplasties make it possible to reduce toe deformities and to protect the integuments of the toes whose deformations are a source of conflict, either by contact with the shoe, or by excessive tightening or by excessive pressure. They also reduce pain in the toes and reduce discomfort when walking or putting on shoes.

Orthoplasties are also used to offload a wound without covering it; to hold the toe in the corrected position during postoperative care. They are also used, in cases of toe amputations, to fill and act as a prosthesis.

The patient must be informed that he will have to gradually wear the orthoplasty and regularly check the absence of skin reaction.

It happens that a reduction, or even a loss of sensitivity, appears following the port of an orthoplasty. Whatever the cause, twice daily for 10 days initially, then daily, the patient and/or caregiver should be encouraged to monitor the condition of the skin in the affected area, looking for areas of hyperpressure, erythema, dermabrasions.

Orthonyxies to avoid having to resort to surgery

Recommended to modify hypercurvature and painful abnormalities of the nail plate and prevent the formation of ingrown nails, orthonyxies (nail orthoses) sometimes make it possible to avoid resorting to surgery . However, they are contraindicated in cases of nail fragility, soft tissue or skeletal tumors.

In the elderly whose skin is fragile, it is preferable to use orthonyxies that do not have any element in contact with the periungual furrow. For these people, staples with titanium wire and lamellas, which are more flexible, are more suitable than staples with steel wire. Orthonyxia is not contraindicated in case of diabetes, arteriopathy or neuropathy.

Onychoplasties

The confections of artificial nail plates are indicated to replace part or all of the nail plate following the appearance of onycholysis (after trauma, infection, hand-foot syndrome, etc.).

Their use is recommended when the soft parts of the furrow or the anterior bead are likely to fill the void left by the nail and to generate secondary conflicts during the regrowth of the nail. Onychoplasties are not indicated in case of wound, tumour, infection or mycosis of the nail apparatus.

Insoles for epidermal affections

In the event of epidermal affections, the podiatrist-podiatrist is the only person authorized to make plantar orthoses (insoles for epidermal affections). These insoles prevent and relieve foot skin disorders.